Future Clinical Trial of Adjuvant Chemotherapy with Sensitivity Test

  • Tetsuro Kubota
  • Yoshihide Otani
  • Koichiro Kumai
  • Masaki Kitajima


There is no doubt that gastrectomy with extended lymph node resection is the curative treatment of choice for gastric cancer. Because some patients undergoing curative resection for gastric cancer relapse, adjuvant cancer chemotherapy has been actively studied. Although many drugs have shown activity against recurrent and advanced gastric cancer, the efficacy of single-agent chemotherapy was limited without increased survival benefit [1]. The response rates after a single agent were reported to be less than 20%, as shown in Table 1, except mitomycin C (MMC), which was tested as single-agent therapy before the present response criteria were introduced. Cisplatin (DDP) was tested against the present criteria of response, and 5-fluorouracil (5-FU) was tested in many patients with gastric cancer; their response rates (21% and 19%, respectively) are considered to be the standard of efficacy for single agents on gastric cancer. Because of the low efficacy of single agents, several combination regimens have been developed: 5-FU + adriamycin (ADM) + MMC (FAM); etoposide + ADM + DDP (EAP); 5-FU + leucovorin (LV) + epirubicin (EPI) (FLEP); and 5-FU + DDP (FP).


Gastric Cancer Adjuvant Chemotherapy Gastric Cancer Patient Advanced Gastric Cancer Resistant Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Schipper DL, Wagener DJ (1996) Chemotherapy of gastric cancer. Anticancer Drugs 7:137–149PubMedCrossRefGoogle Scholar
  2. 2.
    Macdonald JS, Gohmann JJ (1988) Chemotherapy of advanced gastric cancer: present status, future prospects. Semin Oncol 15(Suppl 4):42–49PubMedGoogle Scholar
  3. 3.
    Macdonald JS, Schnall SF (1995) Adjuvant treatment of gastric cancer. World J Surg 19:221–225PubMedCrossRefGoogle Scholar
  4. 4.
    Hermans J, Bonenkamp JJ, Boon MC, Bunt AMG, Ohyama S, Sasako M, Van de Velde CJH (1993) Adjuvant therapy after curative resection for gastric cancer: metaanalysis of randomized trials. J Clin Oncol 11:1441–1447PubMedGoogle Scholar
  5. 5.
    Nakajima T (1995) Review of adjuvant chemotherapy for gastric cancer. World J Surg 19:570–574PubMedCrossRefGoogle Scholar
  6. 6.
    Kubota T, Kumai K, Kitajima M, Fujisaki M, Yamada Y, Ushijima Y, Ishibiki K, Abe O (1994) Dose intensity of mitomycin C in adjuvant cancer chemotherapy for patients with gastric cancer. J Surg Oncol 57:40–45PubMedCrossRefGoogle Scholar
  7. 7.
    Neri B, de Leonardis V, Romano S, Andreoli F, Pernice LM, Bruno L, Borrelli D, Valeri A, Fabbroni S, Intini C, Cini G (1996) Adjuvant chemotherapy after gastric resection in node-positive cancer patients: a multicentre randomised study. Br J Cancer 73:549–552PubMedCrossRefGoogle Scholar
  8. 8.
    Saikawa Y, Kubota T, Furukawa T, Suto A, Watanabe M, Kumai K, Ishibiki K, Kitajima M (1994) Single-cell suspension assay with an MTT end point is useful for evaluating the optimal adjuvant chemotherapy for advanced gastric cancer. Jpn J Cancer Res 85:762–765PubMedCrossRefGoogle Scholar
  9. 9.
    Mosmann T (1983) Rapid colorimetric assay for cellular growth and survival: application to proliferation and cytotoxicity assays. J Immunol Methods 65:55–63PubMedCrossRefGoogle Scholar
  10. 10.
    Shimoyama Y, Kubota T, Watanabe M, Ishibiki K, Abe O (1989) Predictability of in vivo chemosensitivity by in vitro MTT assay with reference to clonogenic assay. J Surg Oncol 41:12–18PubMedCrossRefGoogle Scholar
  11. 11.
    Suto A, Kubota T, Shimoyama Y, Ishibiki K, Abe O (1989) MTT assay with reference to the clinical effect of chemotherapy. J Surg Oncol 42:28–32PubMedCrossRefGoogle Scholar
  12. 12.
    Furukawa T, Kubota T, Suto A, Takahara T, Yamaguchi H, Takeuchi, Kase S, Kodaira S, Ishibiki K, Kitajima M (1991) Clinical usefulness of chemosensitivity testing using the MTT assay. J Surg Oncol 48:188–193PubMedCrossRefGoogle Scholar
  13. 13.
    Furukawa T, Kubota T, Watanabe M, Takahara T, Yamaguchi Ft, Takeuchi T, Kase S, Kodaira S, Ishibiki K, Kitajima M, Hoffman RM (1992) High in vitro-in vivo correlation of drug response using sponge-gel-supported three-dimensional histoculture and the MTT end point. Int J Cancer 51:489–498PubMedCrossRefGoogle Scholar
  14. 14.
    Furukawa T, Kubota T, Watanabe M, Kase S, Takahara T, Yamaguchi H, Takeuchi T, Teramoto T, Ishibiki K, Kitajima M, Hoffman RM (1992) Chemosensitivity testing of clinical gastrointestinal cancers using histoculture and MTT endpoint. Anticancer Res 12:1377–1382PubMedGoogle Scholar
  15. 15.
    Furukawa T, Kubota T, Hoffman RM (1995) Clinical applications of the histoculture drug response assay. Clin Cancer Res 1:305–311PubMedGoogle Scholar
  16. 16.
    Kubota T, Sasano N, Abe O, Nakao I, Kawamura E, Saito T, Endo M, Kimura K, Demura H, Sasano H, Nagura H, Ogawa N, Hoffman RM, Chemosensitivity Group for HDRA (1995) Potential of the histoculture drug response assay to contribute to cancer patient survival. Clin Cancer Res 1:1537–1543PubMedGoogle Scholar
  17. 17.
    Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van Elk P, Obertop H, Gouma DJ, Taat CW, van Lanschot J, de Graaf PW, von Meyenfeldt MF, Tilanuse H, van de Velde CJH (1995) Randomised comparison of morbidity after Dl and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345:745–748PubMedCrossRefGoogle Scholar
  18. 18.
    Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P (1996) Postoperative morbidity and mortality after Dl and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial: the Surgical Cooperative Group. Lancet 347:995–999PubMedCrossRefGoogle Scholar
  19. 19.
    Miwa K (1998) The report of treatment results of stomach cancer in Japan (1990) Miwa Registry-Institute for Stomach Cancer, Tokyo, p 81Google Scholar
  20. 20.
    Nakajima T, Ota K, Ishihara S, Oyama S, Nishi M, Hamashima N (1994) Meta-analysis of 10 postoperative adjuvant chemotherapies for gastric cancer in CIH (in Japanese with English abstract). Gan to Kagaku Ryoho (Jpn J Cancer Chemother) 21:1800–1805Google Scholar
  21. 21.
    Isobe Y, Kubota T, Kubochi K, Shimada A, Shima S, Kitajima M (1998) A prospective study on postoperative chemotherapy directed by the chemosensitivity testing in patients with advanced gastric cancer (in Japanese). Rinsho Geka (J Clin Surg) 53:1285–1289Google Scholar

Copyright information

© Springer Japan 1999

Authors and Affiliations

  • Tetsuro Kubota
    • 1
  • Yoshihide Otani
    • 1
  • Koichiro Kumai
    • 2
  • Masaki Kitajima
    • 1
  1. 1.Department of Surgery, School of MedicineKeio UniversityTokyoJapan
  2. 2.Center for Diagnostic and Therapeutic Endoscopy, School of MedicineKeio UniversityTokyoJapan

Personalised recommendations